Posts filed under 'Type 1 diabetes'
Some time ago I started on a quest to find out the facts about mortality experience of children with type 1 diabetes. The issue I had initially run into was that insurance companies simply would not offer life insurance to children with type 1 diabetes, almost across the board. A few said they would consider it as a highly rated policy if they were over age 15 or over age 19, but most just said no thanks.
I enlisted the expertise of Mike McFarland with Prudential to help me understand why insurance companies were so freaked out by this age group with this problem. I was thinking that surely 1 in every 5 must die before age 20 or there would be at least some high priced product for them. Mr McFarland clued me in that the problem wasn’t the death rate at all, it was the lack of statistics on which to base rates. Insurance companies use mortality tables that go from 0-100, not 0-20, 20-40, etc. They simply didn’t know what mortality experience they would be looking at, making it impossible to design and price a product.
Today the Center for Disease Ccntrol released a study that really centered around the difference in mortality in children with type 1 diabetes and type 2 diabetes, depending on whether they were white or black.
The point I would like to take from this 25 year study is not the difference in deaths per ethnic background, but the fact that compared to other causes of death, death due to diabetes is minuscule. Even using the higher level for blacks, we are talking about 2.5 deaths attributed to diabetes per million.
A child is 60 times more likely to die in a car accident than due to diabetes, 10 times more likely to die of heart disease, 3 times more likely to die from influenza, 4 times more likely to die of respiratory disease, 4 times more liikely due to falling or poisoning and 40 times more likely due to drowning.
Bottom line. It’s time for insurance companies to quit crying wolf, or ignoring the wolf or whatever they are trying to do. There is no fact that would lead to the conclusion that a type 1 diabetes child is uninsurable.
November 21st, 2007
I know that I’ve often heard that the big drug companies really don’t want to find cures for things such as diabetes and it always leaves me shaking my head. Their purported reason for avoiding the cure is that a cure would kill the cash cow they have in selling the life long treatment. I know I’m naive, but that just seems so wrong as to be, well, just so damn wrong. How can a company knowingly subject someone to a lifetime of treating an illness when they have the power to cure.
I know Allie Beatty, whose blog www.lovediabetes.com, has brought major pieces of reality into my world, thinks I wear rose colored glasses. But I wear those glasses with a passion toward knowing and sharing the truth.
And the truth still blows me away. In a New York times article, a story is told about Dr Denise Faustman’s quest to ”cure diabetes. When all signs pointed to her being on the verge of just that, a real cure, her request for research funding was turned down by the drug companies. It was even turned down by the Juvenile Diabetes Research Association.
Funding finally came from Lee Iacocca, whose wife had died from complications of type 1 diabetes. The $11 million dollars he donated and raised has gone a long way toward proving Dr Faustman’s theories correct.
”I can’t wait for the pharmaceutical companies or even government tax money to fund what looks promising,” Mr. Iacocca said. ”They are not known for high risk and they are also slow to react. We are trying to get a cure.
Bottom line. Even when someone is treating their type 1 diabetes and it is well controlled, life insurance can be inordinately expensive. How good would life be if they could put on their life insurance application that they used to have diabetes, but it’s been cured?
November 19th, 2007
All things being equal, underwriting type 1 diabetes and type 2 diabetes really hinge on the same issues. So, why is it that type 1 seems to incur a heavier hit than type 2?
Remember that with type 2 diabetes, underwriting focuses on age of onset, control and other risk factors. The real swing factor is age of onset. After age 50 is the best possible benchmark. 40 to 50 takes a swing into being rated even with good control and other risk factors being well controlled. Onset prior to age 40 will be treated almost the same as type 1.
The reason that age of onset is such a large factor is that, the longer the disease works on a person’s body, the higher the risk of collateral health issues such as heart disease and kidney disease. This is the primary factor in why early onset type 2 and type 1, which is almost always early onset, are underwritten basically the same.
With most type 1 diabetes onset is prior to age 30. Remember, the longer your body has to deal with the stress that diabetes puts on your systems, the harder it is for your body to keep other associated health issues at bay. That is the reality of the way underwriters are currently looking at the two issues.
I am working with underwriters from several companies to review this logic. The truth is that there seems to be a substantial difference in favor of type 1, compared to early onset type 2. Generally speaking, if you have someone with type 1 at age 35, onset age 15, that is exhibiting good control over the disease, they are also someone who has adopted a healthy lifestyle. If they continue to maintain that control, they should have a normal or at least near normal mortality experience.
On the other hand, if someone is diagnosed type 2 at age 35, it is generally because of some poor lifestyle choices, often poor eating habits leading to obesity. At this point the two are starting at the same age and statistics I’ve seen would indicate the person with type 2 is less likely to gain control before suffering collateral health issues. It is my contention, and unfortunately not the contention of the underwriters, that these two are on equal ground. We’re working on that.
Bottom line. Early onset is a problem, a real challenge, no matter which type of diabetes a person is dealing with. Control and a healthy lifestyle are going to win the best life insurance prices available, and for now at least, those prices are higher than later onset.
November 19th, 2007
After a season of disappointment in weight loss reality TV shows, where the tactics took precedence over health, it is refreshing to see someone with a worldwide audience willing to talk about diabetes health issues.
Not that ABC or NBC should gear themselves to meet my expectations, but when the real issue of obesity is not whether a person can lose it, but rather all of the collateral health issues that can happen if they don’t, the mega voices to the world have missed the mark and a golden opportunity.
On the other hand, USA Today has started a 4 days series of articles on several aspects of the diabetes epidemic that is sweeping our country and the world.
USA kicked off their effort with articles on diet and the research into treatment of type 1 diabetes through islet transplantation. “Islets are small organs in the pancreas that contain several types of cells, such as those that produce insulin. A recent study showed that islet transplants can potentially reduce or eliminate the need for insulin injections in diabetes patients and restore the ability of patients to sense low blood sugar levels in 95% of cases.”
Bottom line. While I often go on about diabetes and life insurance, the real need in this issue is for the big voices to get involved and raise public awareness. There is so much going on today in the study of diabetes and treatment, prevention and potential cures, that someone with a much larger megaphone than mine needs to shake things up.
November 16th, 2007
Today is World Diabetes Day. There isn’t a lot I can add to a subject that I post on regularly but to say that anything that can bring more attention and focus to the size and scope of the diabetes problem, is a good thing.
Bottom line. Type 1 diabetes and type 2 diabetes are life changing illnesses. They bring with them a box car load of other potential health issues making acquisition of life insurance a challenge. Through education and advocacy we hope we can make that road just a little bit smoother.
November 15th, 2007
Type 1 diabetes is a disease that can potentially carry a lot of long term health baggage with it. One of the exacerbating issues is that it generally strikes young, usually children or teenagers, who then are faced with a lifetime of controlling their diabetes or facing mortality laced issues.
Children’s Hospital of Pittsburgh is currently doing a follow up study on the effect of oral insulin on delaying or preventing the onset of juvenile diabetes.
A previous study indicated that oral insulin, which has no known side effects, could delay onset of type 1 diabetes by up to four years in people who were at genetically high risk of developing the disease. Because of the long term collateral health issues of type 1 diabetes, any delay in onset could very well be delays in dealing with the other health issues. Prevention of type 1 diabetes would be an obvious home run.
In type 1 diabetes, a person’s own immune cells destroy the beta cells of the pancreas. Beta cells sense blood glucose and produce insulin, which regulates glucose and turns it into energy. When this whole system breaks down your quits producing insulin. “The belief is that insulin introduced via the digestive tract may induce tolerance, quieting the immune system’s attack on itself,” said Dr. Becker, also a professor of Pediatrics at the University of Pittsburgh School of Medicine.
Bottom line. Type 1 diabetes is a roller coaster ride for those who have it and seems to be the same for life insurance underwriters. While I am still working with several companies on the issue of underwriting children with type 1 diabetes, we continue to see progress in underwriting for adults with well controlled type 1.
November 13th, 2007
Over the years, North American Ccmpany for Life and Health has moved in and out of the impaired risk spot light. Overall though, they would have to be judged as one of the better small companies out there.
North American isn’t one of the big boys, but they are still here after 120+ years and there is something to be said for not going away. Having said that, there is a pretty significant rumor milling around that Midland National and North American will be merging soon. Attached is a summary of ratings and stats on both companies.
north-american.pdf
midland-national.pdf
North American has proven to be consistently formidable with the private pilot market. Other companies come and go, but North American has been steady there for years. They also underwrite toward the top of the stack on strokes and some cardiac issues.
In recent history they were leaders in the industry in underwriting type 2 diabetes and cancer, but have become more conservative on that in the past year or so. They have also taken a step backwards on sleep apnea. They are pretty middle of the road on these issues at this point. We are in the process of finding out what direction they will take if they do merge with Midland.
In my memory they have never been good with type 1 diabetes, multiple impairments such as diabetes and heart disease combined, or foreign travel.
Bottom line. One of the reasons that independent agents can be a valuable partner in your search for life insurance is that when a company changes their view on a certain impairment, we’re not stuck there. The winds are always shifting and flexibility is a good thing.
October 19th, 2007
Whether it type 1 diabetes and your choice of insulin types, or type 2 diabetes and your choice of the 5000 oral medications on the market, all anyone with diabetes is looking for is a way to take the stress off their body.
In a post yesterday, Allie Beatty wondered out loud (that is the only way she wonders), why doctors aren’t suggesting vitamins and other natural supplements at the very least, along with the prescribed medication.
I think she makes an excellent point. Whether it is diabetes, heart disease or cancer, adding vitamins and natural supplements certainly isn’t going to hurt. Since they have proven benefits for perfectly healthy people, they are bound to have even more benefits for people who’s bodies are struggling to fight off a disease.
Bottom line. Life insurance underwriters may not be impressed with the fact that you take vitamins, but if you happen to be healthier than someone else with the same disease, they will reward that.
October 19th, 2007
Some months ago I had an interaction with Allie Beatty, a writer for www.thediabetesblog.com. She threw a curve at me concerning the significance of c-peptide in control of type 1 diabetes. I approached several insurance and reinsurance companies to see if they had ever considered considering c-peptide levels in their underwriting for type 1 diabetes. They do test for it on insurance exams. No one ever responded. It seems they stand ready to use out of range c-peptide results against you, but don’t seem ready to embrace normal results as being a favorable thing. Somehow the lack of response was not a surprise to Allie. It kinda ticked me off.
In one of her last posts for the diabetes blog, she threw out a very compelling case for why blood sugar levels alone should not be the sole determinant of control for type 1 diabetes. I suspect we will see this picked up quickly on her new website . I highly recommend that if you have type 1 diabetes or know someone that does, that you take a few minutes a day and follow what she has found to pass on to those who need it.
Will life insurance underwriters shake things up and consider c-peptide? The truth is that they probably won’t any time soon based on the fact that I couldn’t find any that would even discuss it.
Bottom line. For now it would appear that glucose control will be the determinant of diabetes control when it comes to life insurance. My hope is that new doors for treatment will be opened and that as they are, life insurance will become available at affordable rates for more and more people.
September 17th, 2007
I was posed an interesting challenge recently. While I have successfully found affordable life insurance for many adults with type 1 diabetes, I had actually never been asked about life insurance for children with the disease. My usual optimism led me to believe that it was just a matter of asking enough companies, the area where most agents fall short.
After speaking with underwriters in the top 40 or so companies, what I found was a discernible lack of interest in the market. Most companies simply quoted reinsurance guidelines. Depending on what company I talked to they said that they couldn’t consider someone with type 1 diabetes until they were either age 15 or age 20. I did get a few companies that said they would consider younger ages on a case by case basis, but they got real quiet when I asked them for underwriting guidelines (what criteria the younger person would have to meet).
I asked several underwriters why the younger children were uninsurable and they simply stated that “per their guidelines”. No concrete answers, or maybe just too much concrete. I finally had an enlightening discussion with Mike McFarland from Prudential, who said what I was running into, the reason for the knee jerk reaction, was that insurance companies haven’t done mortality studies on children with any severe impairment such as type 1 diabetes, type 2 diabetes, heart disease, etc. They simply don’t have any data upon which to base the pricing for products.
That coupled with the fact that there really isn’t any financial incentive for them to study and create products for a relatively small market that would produce relatively low premium, kind of sets the tone. Well, now the war has been defined and the battles are becoming clearer.
Since the ADA thinks I am just in this as a salesman, I have enlisted help from Allie Beatty who has been blogging her heart out for some time and will soon be launching her own blog at www.lovediabetes.com. Allie has type 1 diabetes and for her age, wow, what a warrior. She has agreed to help arm me with the facts it will take to get a fair audience with insurance companies.
Bottom line. Life insurance companies make big money and for them to cut and run from children just because it might not make them more big bucks, or because they really haven’t done their homework and aren’t interested in doing it, isn’t acceptable. Game on!
September 5th, 2007
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